Pharmaceutical composition for preventing, stabilising and/or inhibiting blood and lymph vascularization

ABSTRACT

A pharmaceutical composition including as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1, wherein the antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml and the use thereof for preventing, stabilizing and/or inhibiting blood and lymph vascularization.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of copending application Ser. No. 12/700,851 filed on Feb. 5, 2010; which claims the benefit of U.S. provisional application Ser. No. 61/150,101 filed Feb. 5, 2009. The entire contents of each of the above-identified applications are hereby incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to a stable ophthalmic composition containing an antisense oligonucleotide GS-101, capable of inhibiting the expression of the insulin receptor substrate-1 (IRS-1) and inhibiting formation of capillary tubes for the treatment of inflammation of the eyes.

BACKGROUND OF THE INVENTION

Angiogenesis is a fundamental process by means of which new blood vessels are formed. This process is essential in multiple normal physiological phenomena such as reproduction, development and even cicatrisation.

The formation of neovessels by endothelial cells, involves the migration, growth and differentiation of endothelial cells. Regulation of these biological phenomena is linked to Insulin receptor substrate 1 (IRS-1), which is a cytoplasmic docking protein that functions as an essential signalling intermediate downstream of activated cell surface receptors, including insulin, insulin-like growth factor 1 (IGF-1), prolactin, growth hormone (GH), vascular endothelial growth factor (VEGFA) receptors, members of the integrin receptor family, and select cytokine receptors.

The normal cornea is devoid of both blood and lymphatic vessels. This avascularity is evolutionary highly conserved to maintain transparency and visual acuity. Nonetheless due to a variety of severe inflammatory diseases the cornea can become invaded by pathologic blood and lymphatic vessels. Inflammatory diseases of the eye, usually linked to pathologic corneal neovascularization, not only reduce corneal transparency, but also are a major risk factor for corneal transplantation.

Those inflammatory diseases of the eyes can be initiated by contact lens misuse, pseudomonas keratitis, herpes simplex keratitis, herpes zoster keratitis, Fuchs-Stevens-Johnson syndrome, prior surgery, alkali burns, graft rejection, degenerative disorders, as well as exposure to ultraviolet light such as sunlight or sunlamps, exposure to other intense light sources such as welding arcs or snow or water reflections, dry eyes caused by an eyelid disorder or insufficient tear formation, a foreign object in the eye, a vitamin A deficiency, or a reaction to eyedrops, eye cosmetics, pollution, or airborne particles such as dust, pollen, mold, or yeast.

In addition, host corneal neovascularization (both pre- as well as post-operatively) is one of the strongest risk factors for subsequent immune rejections after corneal grafting. Corneal graft rejection is primarily a cell-mediated immune response controlled by T cells. Normal corneal immune privilege can be eroded by neovascularisation, especially if accompanied by the sequelae of ocular inflammation and raised intraocular pressure. This is because if neovascularisation is present either before or after a corneal graft, the growth of new blood vessels provides a route of entry for immune-mediating cells to the graft, while the growth of new lymphatic vessels enables the exit of APCs and antigenic material from the graft to regional lymph nodes. The cornea consequently becomes infiltrated with and sensitized to immune reaction mediators. Therefore, although not an immune reaction in itself neovascularisation induces an immune response that can lead to immunological corneal graft rejection.

Conventional therapy, based on corticoids and immunosuppressants, is only partly effective in inhibiting corneal neovascularization. Corticosteroids and immunosuppressive therapy are used but are not very effective and have numerous side effects. There is therefore a need for alternative therapeutic approaches. The inventors previously described in U.S. Pat. No. 7,417,033 a pharmaceutical composition comprising the antisense oligonucleotide GS-101.

GS-101 is a 25 mer phosphorothioate with a molecular weight of 8,036 Da of the following sequence:

5′-TCTCCGGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO : 1) There was still a need to define more precisely the dose and regimen at which said pharmaceutical composition is tolerable, efficient and optimal for preventing, stabilizing and/or inhibiting blood and lymph vascularization in a subject in need thereof.

SUMMARY OF THE INVENTION

One object of the invention is a pharmaceutical composition comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml.

In one embodiment, said antisens oligonucleotide is in a concentration from about 0.80 mg/ml to about 1 mg/ml.

In another embodiment, said pharmaceutical composition is in the form of an aqueous solution, an ointment, micelles or an emulsion.

In one embodiment, the pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

In one embodiment, the aqueous phase of the emulsion further comprises a viscosity modifying agent. Preferably, said viscosity modifying agent is from the group comprising a hydrogel of sodium hyaluronate, polymers of acrylic acid, hydroxyethyl cellulose, dextran, carboxymethyl cellulose, polyethylene glycol, polyvinyl alcohol and collagen.

In one embodiment, the oily phase of the emulsion comprises vegetable oil; triglycerides; monoglycerides; diglycerides; oily fatty acids; isopropyl myristate; oily fatty alcohols; esters of sorbitol and fatty acids; oily sucrose esters, and mineral oils.

In one embodiment, the oily phase of the emulsion comprises a surfactant. Preferably, the surfactant is selected from naturally-occurring gums; naturally-occurring phosphatides; esters or partial esters derived from fatty acids and hexitol anhydrides; condensation products of the said partial esters with ethylene oxide; sorbitan ester; bentonite; glycerin monostearate; glyceryl monooleate and propylene glycol monolaurate or mixtures thereof; glyceryl stearate; poloxamer 188; poloxamer 282; poloxamer 407; tyloxapol; vitamin E D-polyethylene glycol succinate; polyethylene glycol (PEG); cetostearyl alcohol; cholesterol; ethylene glycol palmitostearate; lauric acid; myristic acid; myristyl alcohol; linoleic acid; oleic acid; palmitic acid; polysorbate 20 (Tween 20); sorbitan trioleate (Span 85); phospholipids; and mixture thereof.

In one embodiment, the oily phase of the invention comprises a thickening agent. Advantageously, said thickening agent is selected from the group comprising beeswax, hard paraffin and cetylic alcohol.

In one embodiment, the emulsion of the invention further comprises an osmolality modifying agent. Preferably, said osmolality modifying agent is selected from the group comprising NaCl, KCl, CaCl2, glycerol, mannitol, alpha-trehalose and propylene-glycol.

In one embodiment, the emulsion of the invention further comprises urea.

In one embodiment of the invention, said antisens oligonucleotide is present in the emulsion of the invention in a concentration from about 0.10 mg/ml to about 3 mg/ml.

In one embodiment, the emulsion of the invention comprises

-   -   an aqueous phase, wherein the amount of the aqueous phase in the         emulsion ranges from about 70 to 99% in weight to the total         weight of the emulsion; and     -   an oily phase, wherein the amount of the oily phase in the         emulsion ranges from about 1 to about 30% in weight to the total         weight of the emulsion;         wherein     -   the aqueous phase comprises:         -   an antisense oligonucleotide having the sequence SEQ ID NO:             1 or any function-conservative sequence comprising from 9 to             30 nucleotides that has 75% of identity compared to SEQ ID             NO: 1; in an amount ranging from about 0.01 to about 0.3% in             weight to the total weight of the emulsion; and         -   polymers of acrylic acid in an amount ranging from about             0.01 to about 0.1% in weight to the total weight of the             emulsion; and         -   NaOH in an amount ranging from about 0.1 to about 0.5% in             weight to the total weight of the emulsion; and         -   optionally urea, in an amount ranging from about 0.5 to             about 20% in weight to the total weight of the emulsion; and     -   the oily phase comprises:         -   Medium Chain Triglycerides (MCT), in an amount ranging from             about 1 to about 20% in weight to the total weight of the             emulsion; and         -   a mixture of glyceryl stearate and of PEG-75 in an amount             ranging from about 1 to about 10% in weight to the total             weight of the emulsion; and         -   cetylic alcohol in an amount ranging from about 0.1 to about             10% in weight to the total weight of the emulsion; and         -   optionally glycerol in an amount ranging from about 0.5 to             about 25% in weight to the total weight of the emulsion.

In another embodiment, said pharmaceutical composition is for preventing, stabilizing or inhibiting blood and lymph vascularization.

In another embodiment, said pharmaceutical composition is for treating corneal graft rejection, glaucoma, retinopathy, retinopathy of prematurity, age related macular degeneration and diabetic retinopathy.

Another object of the invention is a method for preventing, stabilizing and/or inhibiting blood and/or lymph vascularization, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

Another object of the invention is a method for treating a disease of the posterior segment of the eye, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

Another object of the invention is a method for treating retinopathy comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

Another object of the invention is a method for treating age related macular degeneration, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

Another object of the invention is a method for treating choroidal neovascularization by reducing the number of grade III or grade IV lesions, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising:

-   -   an aqueous phase comprising as active agent, an antisens         oligonucleotide having the sequence SEQ ID NO: 1 or any         function-conservative sequence comprising from 9 to 30         nucleotides that has 75% of identity compared to SEQ ID NO: 1,         wherein said antisens oligonucleotide is in a concentration from         about 0.40 mg/ml to about 2 mg/ml; and     -   an oily phase dispersed in the aqueous phase.

In another embodiment, said pharmaceutical composition is to be administrated topically, by intravitreal injection or by intraconjunctivial injection.

In another embodiment, said pharmaceutical composition is to be administrated in the form of eye drop once, twice, or more per day.

In another embodiment, the amount of antisens oligonucleotide in the pharmaceutical composition to be administrated daily per eye is from about 8 μg to about 40 μg.

In another embodiment, the amount of antisens oligonucleotide in the pharmaceutical composition to be administrated daily per eye is from about 40 μg to about 100 μg per drop.

Another object of the invention is a unit dose container comprising the pharmaceutical composition as described here above

In one embodiment, said unit dose is capable of dispensing eye drops.

DETAILED DESCRIPTION OF THE INVENTION

One object of the invention is a pharmaceutical composition comprising as active agent, an antisense oligonucleotide having the sequence SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml.

As used herein, the term “about” preceding a figure means plus or less 10% of the value of said figure

Said antisense oligonucleotide has for nucleic sequence the sequence SEQ ID NO: 1

5′-TCTCCGGAGGGCTCGCCATGCTGCT-3′ or any function conservative sequence comprising from 9 to 30 nucleotides that has 75%, 80%, 85%, 90%, 95% or more than 95%, 96%, 97%, 98%, 99% of identity compared to SEQ ID NO: 1 and that conserves the capacity of inhibiting IRS-1 gene expression as SEQ ID NO: 1. Said function conservative sequence comprising 9 to 30 nucleotides may be a sequence comprising SEQ ID NO: 1 or SEQ ID NO: 2 between other nucleic acids in C-terminal and N-terminal. Said function conservative sequence may also be a 9 to 12 contiguous nucleotides fragment of SEQ ID NO: 1 or SEQ ID NO: 2.

An example of a function conservative sequence of SEQ ID NO: 1 is SEQ ID NO: 2 (5′-TATCCGGAGGGCTCGCCATGCTGCT-3′). Other examples of a function conservative sequence of SEQ ID NO: 1 are the following sequences:

5′-TCTCCGGAGGGCTCGCCATGCTGC-3′ (SEQ ID NO: 3) 5′-TCTCCGGAGGGCTCGCCATGCTG-3′ (SEQ ID NO: 4) 5′-TCTCCGGAGGGCTCGCCATGCT-3′ (SEQ ID NO: 5) 5′-TCTCCGGAGGGCTCGCCATGC-3′ (SEQ ID NO: 6) 5′-TCTCCGGAGGGCTCGCCATG-3′ (SEQ ID NO: 7) 5′-TCTCCGGAGGGCTCGCCAT-3′ (SEQ ID NO: 8) 5′-CTCCGGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 9) 5′-TCCGGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 10) 5′-CCGGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 11) 5′-CGGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 12) 5′-GGAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 13) 5′-GAGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 14) 5′-AGGGCTCGCCATGCTGCT-3′ (SEQ ID NO: 15) 5′-GGCTCGCCATGCTGCT-3′ (SEQ ID NO: 16) 5′-GCTCGCCATGCTGCT-3′ (SEQ ID NO: 17) 5′-CTCGCCATGCTGCT-3′ (SEQ ID NO: 18) 5′-TCGCCATGCTGCT-3′ (SEQ ID NO: 19) 5′-CGCCATGCTGCT-3′ (SEQ ID NO: 20) Said antisense oligonucleotides may be synthesized by all methods well known by the person skilled in the art, such as chemical synthesis.

In one embodiment, said pharmaceutical composition comprises from 0.40 mg/ml to 1.75 mg/ml of said antisense oligonucleotide.

In one embodiment, said pharmaceutical composition comprises from 0.50 mg/ml to 1.75 mg/ml of said antisense oligonucleotide.

In another embodiment, said pharmaceutical composition comprises from about 0.60 mg/ml to about 1.5 mg/ml of said antisense oligonucleotide.

In another embodiment, said pharmaceutical composition comprises from about 0.70 mg/ml to about 1.25 mg/ml of said antisense oligonucleotide.

In another embodiment, said pharmaceutical composition comprises from about 0.80 mg/ml to about 1 mg/ml of said antisense oligonucleotide.

In another embodiment, said pharmaceutical composition comprises from about 0.8 mg/ml to about 0.90 mg/ml of said antisense oligonucleotide.

In one embodiment, said pharmaceutical composition comprises from about 0.40 mg/ml to about 0.50 mg/ml of said antisense oligonucleotide, preferably about 0.43 mg/ml.

In another embodiment, said pharmaceutical composition comprises from about 0.80 mg/ml to about 0.90 mg/ml of said antisense oligonucleotide, preferably about 0.86 mg/ml.

In another embodiment, said pharmaceutical composition comprises from about 1.60 mg/ml to about 1.80 mg/ml of said antisense oligonucleotide, preferably about 1.70 mg/ml.

Another object of the invention is the pharmaceutical composition as described here above for preventing, stabilizing or inhibiting blood and lymph vascularization or for use in preventing, stabilizing and/or inhibiting blood and lymph vascularization.

Another object of the invention is a method for preventing, stabilizing and/or inhibiting blood and lymph vascularization in a subject in need thereof, comprising administering to said subject a pharmaceutical composition as described hereabove.

In one embodiment, the pharmaceutical composition as described here above is useful for preventing, stabilizing and/or inhibiting blood and lymph vascularization in the cornea, in the anterior chamber of the eye, in the posterior chamber of the eye, in the macula, in the retina and/or in the choroid.

As used herein, the term “subject” refers to a mammal, preferably a human, but also can refer to animals, for example, cats, dogs, mice, cows, horses, pigs, and the like.

Especially, the invention aims at addressing blood and lymph neovascularization.

Also, a specific object of the invention is prevention, stabilization and/or inhibition of corneal angiogenesis, especially corneal vascularization or corneal neovascularization.

The pharmaceutical composition of the invention may be formulated into a variety of topically or injectable administrable ophthalmic compositions, such as solutions, suspensions, gels, ointments, micelles and emulsions such as water-in-oil emulsion or oil-in-water emulsion, the emulsion being cationic or anionic.

A liquid which is ophthalmically acceptable is formulated such that it can be administered topically to the eye. The comfort should be maximized as much as practicable, although sometimes formulation considerations (e.g. drug stability, bioavailability, etc.) may necessitate less than optimal comfort. In the case that comfort cannot be maximized, the liquid should be formulated such that the liquid is tolerable to the patient for topical ophthalmic use. Additionally, an ophthalmically acceptable liquid should either be packaged for single use, or contain a preservative to prevent contamination over multiple uses.

Usually, said ophthalmic pharmaceutical composition is sterile.

For ophthalmic application, solutions or medicaments are often prepared using a physiological saline solution as a major vehicle. Ophthalmic solutions are often maintained at a comfortable pH (usually within the range of pH 5.5-8) and an ophthalmically acceptable osmolality (generally about 150-450 mOsm, preferably 250-350 mOsm).

The formulations may also contain conventional, pharmaceutically acceptable preservatives, stabilizers and surfactants.

Various buffers and means for adjusting pH may be used so long as the resulting preparation is ophthalmically acceptable. Accordingly, buffers include, but are not limited to, acetate buffers, citrate buffers, phosphate buffers and borate buffers. Acids or bases may be used to adjust the pH of these formulations as needed.

In another embodiment, the composition contains a preservative. Preservatives that may be used in the pharmaceutical compositions disclosed herein include, but are not limited to, cationic preservatives such as quaternary ammonium compounds including benzalkonium chloride, polyquad, and the like; guanidine-based preservatives including PHMB, chlorhexidine, and the like; chlorobutanol; mercury preservatives such as thimerosal, phenylmercuric acetate and phenylmercuric nitrate; and oxidizing preservatives such as stabilized oxychloro complexes.

In another embodiment, the composition contains a surfactant. A surfactant may be used for assisting in dissolving an excipient or an active agent, dispersing a solid or liquid in a composition, enhancing wetting, modifying drop size, or a number of other purposes. Useful surfactants include, but are not limited to surfactants of the following classes: alcohols; amine oxides; block polymers; carboxylated alcohol or alkylphenol ethoxylates; carboxylic acids/fatty acids; ethoxylated alcohols; ethoxylated alkylphenols; ethoxylated aryl phenols; ethoxylated fatty acids; ethoxylated; fatty esters or oils (animal & veg.); fatty esters; fatty acid methyl ester ethoxylates; glycerol esters; glycol esters; lanolin-based derivatives; lecithin and lecithin derivatives; lignin and lignin derivatives; methyl esters; monoglycerides and derivatives; polyethylene glycols; polymeric surfactants; propoxylated & ethoxylated fatty acids, alcohols, or alkyl phenols; protein-based surfactants; sarcosine derivatives; sorbitan derivatives; sucrose and glucose esters and derivatives.

In particular, ethoxylate surfactants are useful. An ethoxylate surfactants is one that comprises the moiety —O(CH2CH2O)n—OH, wherein n is at least about 1.

In one embodiment n is from about 1 to about 10,000. In another embodiment, n is from 1 to about 1000. In another embodiment, n is from about 1 to about 500. Some ethoxylates contain one ethoxylate moiety. In other words, there is a single ethoxylate chain on each molecule.

Examples of surfactants with one ethoxylate moiety, include, but are not limited to Ethoxylated alcohols wherein the alcohol has a single hydroxyl unit; alkylphenol ethoxylates; ethoxylated fatty acids; fatty acid methyl ester ethoxylates; polyethylene glycols; and the like.

Ethoxylates may comprise more than one ethoxylate moiety. In other words, there may be ethoxylate moieties attached to several different parts of the molecule. Examples include, but are not limited to: block polymers; ethoxylated oils; sorbitan derivatives; sucrose and glucose ethoxylates; and the like.

Block Polymers are polymers with the structure A-B-A′, wherein A and A′ are polyethylene chains of 1 or more ethylene units, and B is a polypropylene chain of one or more propylene units. Generally, but not necessarily, A and A′ are approximately the same length.

In one embodiment, A and A′ contain from about 2 to about 200 ethylene units. In another embodiment, A and A′ contain from about 5 to about 100 ethylene units. In another embodiment, A and A′ contain about 7 to about 15 ethylene units. In another embodiment, A and A′ contain about 7, about 8, or about 12 ethylene units. In another embodiment, B contains from about 25 to about 100 propylene units. In another embodiment, B contains from about 30 to about 55 propylene units. In another embodiment, B contains about 30, about 34, or about 54 propylene units. In another embodiment, the molecular weight is from about 1000 to about 20000. In another embodiment, the molecular weight is from about 2000 to about 10000. In another embodiment, the molecular weight is about 2500, about 3000, about 3800, or about 8400.

Block Polymers include but are not limited to:

-   -   Poloxalene: wherein A has about 12 ethylene oxide units, B has         about 34 propylene oxide units, A′ has about 12 ethylene oxide         units, and the average molecular weight is about 3000.     -   Poloxamer 182: wherein A has about 8 ethylene oxide units, B has         about 30 propylene oxide units, A′ has about 8 ethylene oxide         units, and the average molecular weight is about 2500.     -   Poloxamer 188: wherein A has about 75 ethylene oxide units, B         has about 30 propylene oxide units, A′ has about 75 ethylene         oxide units, and the average molecular weight is about 8400.     -   Poloxamer 331: wherein A has about 7 ethylene oxide units, B has         about 54 propylene oxide units, A′ has about 7 ethylene oxide         units, and the average molecular weight is about 3800.

Ethoxylated Alcohols include but are not limited to:

-   -   Ethoxylates of linear alcohols having from about 6 to about 20         carbon atoms. In one embodiment, the linear alcohol has from         about 10 to about 16 carbon atoms. In another embodiment, n is         from about 1 to about 100. In another embodiment, n is from         about 1 to about 50. In another embodiment, n is from about 5 to         about 50 ethylene oxide units. In another embodiment, n is from         about 1 to about 20 ethylene oxide units. In another embodiment,         n is from about 30 to about 50 ethylene oxide units.     -   Ethoxylated Alkylphenols which are alkylphenols that are         ethoxylated, i.e. the phenolic OH is replaced with an ethoxylate         moiety. These include but are not limited to: octylphenol         ethoxylate, i.e. C8H17Ph(OCH2CH2O)nH. nonylphenol ethoxylate,         i.e. C9H19Ph(OCH2CH2O)nH. alkyphenols of the above formula         wherein n is from about 1 to about 100.     -   Ethoxylated Fatty Acids, which include but are not limited to:         ethoxylates which are esterified to form either: monoesters,         i.e. RCO2(CH2CH2O)nOH, where RCO2H is a fatty acid; or diesters,         i.e. RCO2(CH2CH2O)nC(=0)R.

Fatty acids include, but are not limited to: (1) saturated fatty acids, which have no C═C moieties and include myristic acid, palmitic acid, stearic acid, arachidic acid, behenic acid, lignoceric acid; and (2) unsaturated fatty acids, including the following: monounsaturated fatty acids, which have one C═C group such as palmitoleic acid, oleic acid, and nervonic acid; diunsaturated fatty acids, which have two C═C groups, such as linoleic acid; triiunsaturated fatty acids, which have three C═C groups, such as [alpha]-linolenic acid and [gamma]-linolenic acid; tetraunsaturated fatty acids, which have four C═C groups, such as arachidonic acid; and pentaunsaturated fatty acids, which have five C═C groups, such as eicosapentaenoic acid. The following may also be used: Laurie Acid; 14 carbon fatty acids such as myristic acid; 16 carbon fatty acids such as palmitic and palmitoleic acid; 18 carbon fatty acids such as stearic acid, oleic acid, linoleic acid, [alpha]-linolenic acid, and [gamma]-linolenic acid; 20 carbon fatty acids such as eicosapentaenoic acid; 22 carbon fatty acids such as arachidic acid; and 24 carbon carbon fatty acids such as lignoceric acid and nervonic acid.

Ethoxylated Fatty Esters or Oils (Animal & Veg.) are products which result from reacting ethylene oxide with a fatty ester or an oil. When a fatty oil is used, the products is a mixture of ethoxylates of the fatty acids present in the oil, ethoxylates of glycerine, ethoxylates of mono and diglycerides, and the like. Specific examples include, but are not limited to: Ethoxylates of the following oils: Anise oil, Castor oil, Clove oil, Cassia oil, Cinnamon oil; Almond oil, Corn oil, Arachis oil, Cottonseed oil, Safflower oil, Maize oil, Linseed oil, Rapeseed oil, Soybean oil, Olive oil, Caraway oil, Rosemary oil, Peanut oil, Peppermint oil, Sunflower oil, Eucalyptus oil and Sesame oil; Coriander oil, Lavender oil, Citronella oil, Juniper oil, Lemon oil, Orange oil, Clary sage oil, Nutmeg oil, Tea tree oil, coconut oil, tallow oil, and lard. In one embodiment, from 1 to about 50 moles of ethylene oxide is used per mole of the oil triglyceride. In another embodiment, from about 30 to about 40 moles of ethylene oxide is used per mole of the oil triglyceride.

Ethylene oxide may also react with a fatty acid ester with a formula RCO2R′ to form RCO2(CH2CH2O)nR'. Thus, surfactants having the formula RCO2(CH2CH2O)nR′, where RCO2H is a fatty acid and R′ is alkyl having from 1 to 6 carbons are contemplated. One embodiment is a fatty acid methyl ester ethoxylate, wherein R′ is methyl.

In another embodiment, RCO2H is Lauric Acid; a 14 carbon fatty acid such as myristic acid; a 16 carbon fatty acid such as palmitic and palmitoleic acid; an 18 carbon fatty acids such as stearic acid, oleic acid, linoleic acid, [alpha]-linolenic acid, and [gamma]-linolenic acid; a 20 carbon fatty acids such as eicosapentaenoic acid; a 22 carbon fatty acids such as arachidic acid; or a 24 carbon carbon fatty acids such as lignoceric acid and nervonic acid. Polyethylene Glycols are ethoxylates that are unsubstituted, or terminated with oxygen on both ends, i.e. HO(CH2CH2O)nH,

Sorbitan Derivatives are ethoxylated sorbates having a fatty acid capping one or more of the ethoxylated chains. These include but are not limited to: (A) sorbitan derivatives wherein the total number of ethylene oxide units is from 3 to 30; (B) sorbitan derivatives wherein the total number of ethylene oxide units is 4, 5, or 20; (C) sorbitan derivatives wherein the capping acid is laurate, palmitate, stearate, or oleate; The sorbitan derivative may be a POE sorbitan monolaurate; a POE sorbitan dilaurate; a POE sorbitan trilaurate; a POE sorbitan monopalmitate; a POE sorbitan dipalmitate; a POE sorbitan tripalmitate; a POE sorbitan monostearate; a POE sorbitan distearate; a POE sorbitan tristearate; a POE sorbitan monooleate; a POE sorbitan dioleate; or a POE sorbitan trioleate; Specific examples include: POE (20) sorbitan monolaurate; POE (4) sorbitan monolaurate; POE (20) sorbitan monopalmitate; POE (20) monostearate; POE (20) sorbitan monostearate; POE (4) sorbitan monostearate; POE (20) sorbitan tristearate; POE (20) sorbitan monoleate; POE (20) sorbitan 15 monoleate; POE (5) sorbitan 10 monoleate; POE (20) sorbitan trioleate.

Sucrose and Glucose Esters and Derivatives include, but are not limited to, polyvinyl alcohol, povidone, hydroxypropyl methyl cellulose, poloxamers, carboxymethyl cellulose, hydroxyethyl cellulose, and acrylates (e.g. Pemulen®).

Tonicity adjustors may be added as needed or convenient. They include, but are not limited to, salts, particularly sodium chloride, potassium chloride, mannitol and glycerin, or any other suitable ophthalmically acceptable tonicity adjustor.

In a similar vein, an ophthalmically acceptable antioxidant includes, but is not limited to, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole and butylated hydroxytoluene.

Other excipient components which may be included in the ophthalmic preparations are chelating agents. A useful chelating agent is edetate disodium, although other chelating agents may also be used in place or in conjunction with it.

The present compositions in the form of aqueous suspensions may include excipients suitable for the manufacture of aqueous suspensions. Such excipients are suspending agents, for example, sodium carboxymethylcellulose, methylcellulose, hydroxypropyl-methylcellulose, sodium alginate, polyvinylpyrrolidone, gun tragacanth and gun acacia; dispersing or wetting agents may be a naturally occurring phosphatide, for example, lecithin, or condensation products of ethylene oxide with long chain aliphatic alcohols, for example, heptadeca-ethyleneoxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol such as polyoxyethylene sorbitol mono-oleate, or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, for example, polyoxyethylene sorbitan mono-oleate, and the like and mixtures thereof.

The present compositions in the form of oily suspensions may be formulated in a vegetable oil, for example, olive oil, castor oil, soy oil, sesame oil or coconut oil, or in a mineral oil such as liquid paraffin. Such suspensions may contain a thickening agent, for example beeswax, hard paraffin or cetyl alcohol.

The present compositions may also be in the form of emulsions. In one embodiment, the present compositions are in the form of oil-in-water emulsions.

In one embodiment, the emulsion of the invention comprises an aqueous phase and an oily phase dispersed in the aqueous phase, wherein:

-   -   the percentage of the aqueous phase ranges from about 70 to         about 99% in weight to the total weight of the emulsion,         preferably from about 75% to about 85% w/w, more preferably is         of about 81.5%; and wherein     -   the percentage of the oily phase ranges from about 1 to about         30% in weight to the total weight of the emulsion, preferably         from about 10 to about 20% w/w, more preferably is of about         18.5%.

In one embodiment of the invention, the antisense oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1 is present in the aqueous phase of the hereinabove described emulsion.

In one embodiment, the amount of the antisense oligonucleotide as hereinabove defined ranges from about 0.01% to about 0.3% in weight to the total weight of the emulsion, preferably from about 0.04% to about 0.20% w/w, more preferably is of about 0.172%.

In one embodiment, the amount of the antisense oligonucleotide as hereinabove defined ranges from about 0.01% to about 0.3% in weight to the total weight of the aqueous phase f the emulsion, preferably from about 0.04% to about 0.25% w/w, more preferably is of about 0.211%.

In one embodiment of the invention, the aqueous phase of the emulsion further comprises a viscosity modifying agent. Examples of viscosity modifying agents include, but are not limited to, a hydrogel of sodium hyaluronate, polymers of acrylic acid, for example polymers of acrylic acids cross-linked with polyalkenyl ethers or divinyl glycol, such as, for example, Carbopol® gels, hydroxyethyl cellulose, dextran, carboxymethyl cellulose, polyethylene glycol, polyvinyl alcohol and collagen.

In an embodiment of the invention, the viscosity modifying agent is a Carbopol®, such as, for example, Carbopol® 980 NF.

In one embodiment of the invention, the amount of the viscosity modifying agent in the emulsion ranges from about 0.01% to about 0.1% in weight to the total weight of the emulsion, preferably from about 0.03 to about 0.08% w/w, more preferably is of about 0.05% w/w.

In one embodiment of the invention, the amount of the viscosity modifying agent in the emulsion ranges from about 0.01% to about 0.2% in weight to the total weight of the aqueous phase of the emulsion, preferably from about 0.03 to about 0.1% w/w, more preferably is of about 0.061% w/w.

The oil comprised in the oily phase may be a vegetable oil, for example, castor oil, olive oil, soy oil, sesame oil, cotton seed oil, sweet almond oil or arachis oil; triglycerides, such as, for example, semi-synthetic oils (medium chains triglycerides (MCT) or long chain triglycerides); monoglycerides; diglycerides; oily fatty acids; isopropyl myristate; oily fatty alcohols; esters of sorbitol and fatty acids, oily sucrose esters, or a mineral oil, for example, liquid paraffin or petrolatum; and in general any oily substance which is physiologically tolerated and mixtures thereof.

In an embodiment, the oily phase of the emulsion comprises MCT, i.e. a triglyceride oil in which the carbohydrate chain has about 8-12 carbon atoms. Example of MCT oil which may be used in emulsions of the present invention is Miglyol 812TH (Dynamit Novel, Sweden).

In one embodiment of the invention, the amount of the oil in the emulsion ranges from about 1 to about 20% in weight to the total weight of the emulsion, preferably from about 5% to about 10% w/w, more preferably is of about 8% w/w.

In one embodiment of the invention, the amount of the oil in the emulsion ranges from about 25 to about 75% in weight to the total weight of the oily phase of the emulsion, preferably from about 35% to about 50% w/w, more preferably is of about 43.2% w/w.

In one embodiment of the invention, the oily phase comprises at least one emulsifying agent. As used herein, the term “emulsifying agent” may be used interchangeably with surfactant. Suitable surfactants are listed hereinabove. Other examples of suitable emulsifying agents include, but are not limited to naturally-occurring gums, for example, gum acacia or gum tragacanth; naturally-occurring phosphatides, for example, soya bean lecithin, and esters or partial esters derived from fatty acids and hexitol anhydrides, for example, sorbitan mono-oleate, and condensation products of the said partial esters with ethylene oxide, for example, polyoxyethylene sorbitan mono-oleate; sorbitan ester such as, for example, sorbitan stearate, sorbitan mono laurate, polyoxyethylene sorbitan mono oleate and sorbitan monopalmitate; bentonite; glycerin monostearate; glyceryl monooleate and propylene glycol monolaurate or mixtures thereof; glyceryl stearate; poloxamer 188; poloxamer 282; poloxamer 407; tyloxapol; vitamin E D-polyethylene glycol succinate; polyethylene glycol (PEG)(such as, for example, PEG 75); cetostearyl alcohol; cholesterol; ethylene glycol palmitostearate; lauric acid; myristic acid; myristyl alcohol; linoleic acid; oleic acid; palmitic acid; polysorbate 20 (Tween 20), sorbitan trioleate (Span 85), phospholipids such as egg lecithin stearic acid oleyl alcohol; and mixture thereof.

In one embodiment, the emulsion of the invention comprises glyceryl stearate and PEG75 as emulsifying agent in the oily phase. A mixture of glyceryl stearate and PEG75 is commercially available as Gelot 64® (Gattefosse, France).

In one embodiment, the amount of emulsifying agent in the emulsion ranges from about 1% to about 10% in weight to the total weight of the emulsion, preferably from about 2.5 to about 5% w/w, more preferably is of about 3.5% w/w.

In one embodiment, the amount of emulsifying agent in the emulsion ranges from about 5% to about 40% in weight to the total weight of the emulsion, preferably from about 10 to about 30% w/w, more preferably is of about 18.9% w/w.

In one embodiment, the oily phase of the emulsion further comprises a thickening agent. Examples of suitable thickening agents include, but are not limited to, beeswax, hard paraffin and cetylic alcohol. Advantageously, said thickening agent is cetilyc alcohol.

In one embodiment, the amount of thickening agent in the emulsion ranges from about 0.1% to about 10% in weight to the total weight of the emulsion, preferably from about 0.5 to about 5% w/w, more preferably is of about 2% w/w.

In one embodiment, the amount of thickening agent in the emulsion ranges from about 1% to about 30% in weight to the total weight of the oily phase of the emulsion, preferably from about 5 to about 20% w/w, more preferably is of about 10.8% w/w

In one embodiment, the emulsion further comprises an osmolality modifying agent. Examples of suitable osmolality modifying agents include, but are not limited to, NaCl, KCl, CaCl2, glycerol, mannitol, alpha-trehalose and propylene-glycol. Advantageously, the osmolality modifying agent is comprised in the oily phase of the emulsion. An example of suitable osmolality modifying agent present in the oily phase of the emulsion is glycerol.

In one embodiment of the invention, the amount of osmolality modifying agent in the emulsion ranges from about 0.5% to about 25% in weight to the total weight of the emulsion, preferably from about 1 to about 10% w/w, more preferably is of about 5% w/w.

In one embodiment of the invention, the amount of osmolality modifying agent in the emulsion ranges from about 10% to about 45% in weight to the total weight of the oily phase of the emulsion, preferably from about 20 to about 35% w/w, more preferably is of about 27% w/w.

In one embodiment, the emulsion of the invention further comprises a pH buffering agent. Advantageously, the pH buffering agent is present in the aqueous phase of the emulsion. In one embodiment of the invention, the pH of the emulsion is constant, and ranges from about 6 to about 8, preferably is of about 7. Suitable examples of pH buffering agents include, but are not limited to, NaOH, phosphate buffer, citrate buffer, tris buffer, histiding buffer and acetate buffer. Advantageously, the pH buffering agent is NaOH.

In one embodiment of the invention, the amount of pH buffering agent in the emulsion ranges from about 0.1% to about 0.5% in weight to the total weight of the emulsion, preferably from about 0.2 to about 0.4% w/w, more preferably is of about 0.29% w/w.

In one embodiment of the invention, the amount of pH buffering agent in the emulsion ranges from about 0.2% to about 0.5% in weight to the total weight of the aqueous phase of the emulsion, preferably from about 0.3 to about 0.4% w/w, more preferably is of about 0.35% w/w.

In one embodiment of the invention, the composition of the invention further comprises urea. Urea may help to denature secondary structures in the antisense oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1 present in the composition of the invention.

Preferably, when the composition of the invention is an emulsion, urea is comprised in the aqueous phase of the emulsion.

In one embodiment, the amount of urea in the composition of the invention ranges from about 0.5% to about 20% in weight to the total weight of the composition, preferably from about 1 to about 10% w/w, more preferably is of about 4% w/w.

In one embodiment, the amount of urea in the composition of the invention ranges from about 0.5% to about 20% in weight to the total weight of the aqueous phase of the emulsion of the invention, preferably from about 1 to about 10% w/w, more preferably is of about 4.9% w/w.

The present invention also refers to an oil-in-water emulsion comprising:

-   -   an aqueous phase, wherein the amount of the aqueous phase in the         emulsion ranges from about 70 to 99% in weight to the total         weight of the emulsion, preferably is of about 81.5% w/w; and     -   an oily phase, wherein the amount of the oily phase in the         emulsion ranges from about 1 to about 30% in weight to the total         weight of the emulsion, preferably is of about 18.5%;         wherein     -   the aqueous phase comprises:         -   an antisense oligonucleotide having the sequence SEQ ID NO:             1 or any function-conservative sequence comprising from 9 to             30 nucleotides that has 75% of identity compared to SEQ ID             NO: 1; in an amount ranging from about 0.01 to about 0.3%,             preferably 0.172% in weight to the total weight of the             emulsion, or ranging from about 0.04 to about 0.3%,             preferably 0.21% in weight to the weight of the aqueous             phase; and         -   optionally, a viscosity modifying agent, preferably             Carbopol® 980 NF; in an amount ranging from about 0.01 to             about 0.1, preferably of about 0.05% in weight to the total             weight of the emulsion, or ranging from about 0.01% to about             0.2%, preferably of about 0.061% in weight to the weight of             the aqueous phase; and         -   optionally, a pH buffering agent, preferably NaOH, in an             amount ranging from about 0.1 to about 0.5, preferably of             about 0.29% in weight to the total weight of the emulsion,             or ranging from about 0.2% to about 0.5%, preferably of             about 0.35% in weight to the weight of the aqueous phase;             and         -   optionally, urea, in an amount ranging from about 0.5 to             about 20, preferably of about 4% in weight to the total             weight of the emulsion, or ranging from about 0.5% to about             20%, preferably of about 4.9% in weight to the weight of the             aqueous phase; and     -   the oily phase comprises:         -   an oil, preferably MCT, more preferably Miglyol 812N, in an             amount ranging from about 1 to about 20, preferably of about             8% in weight to the total weight of the emulsion, or ranging             from about 25% to about 75%, preferably of about 43.2% in             weight to the weight of the oily phase; and         -   optionally, at least one emulsifying agent, preferably a             mixture of glyceryl stearate and of PEG-75; in an amount             ranging from about 1 to about 10, preferably of about 3.5%             in weight to the total weight of the emulsion, or ranging             from about 5% to about 40%, preferably of about 18.9% in             weight to the weight of the oily phase; and         -   optionally a thickening agent, preferably cetylic alcohol;             in an amount ranging from about 0.1 to about 10, preferably             of about 2% in weight to the total weight of the emulsion,             or ranging from about 1% to about 30%, preferably of about             10.8% in weight to the weight of the oily phase; and         -   optionally, an osmolality modifying agent, preferably             glycerol; in an amount ranging from about 0.5 to about 25,             preferably of about 5% in weight to the total weight of the             emulsion, or ranging from about 10% to about 45%, preferably             of about 27% in weight to the weight of the oily phase. Also             included within the scope of this invention are preserved             compounds which increase in viscosity upon administration to             the eye. For example, “gelling polysaccharides” which are             disclosed in U.S. Pat. No. 5,212,162, which is incorporated             in its entirety herein by reference. Also disclosed in this             patent are ophthalmic formulations containing carrageenans             and furcellarans which are administered as partially gelled             liquids which gel upon instillation into the eye.             Additionally, U.S. Pat. No. 4,136,173, U.S. Pat. No.             4,136,177, and U.S. Pat. No. 4,136,178, disclose the use of             therapeutic compositions containing xanthan gum and locust             bean gum which are delivered in liquid form to the eye and             which gel upon instillation. U.S. Pat. No. 4,861,760             discloses ophthalmological compositions containing gellan             gum which are administered to the eye as non-gelled liquids             and which gel upon instillation. Each of these four patients             is incorporated in its entirety herein by reference. Also             within the scope of this invention are preserved oils,             ointments, gels and the like.

In one embodiment, the composition is formulated in accordance with routine procedures as a pharmaceutical composition adapted for topical administration to human beings.

In another embodiment, the composition is formulated in accordance with routine procedures as a pharmaceutical composition adapted for intraconjunctivial injection to human beings.

In another embodiment, the composition is formulated in accordance with routine procedures as a pharmaceutical composition adapted for intravitreal injection to human beings.

In one embodiment of the invention, said pharmaceutical composition as described here above is packaged in the form of unit dose.

In one embodiment, said unit dose is a container capable of dispensing eye drops such as common manual bulb-operated pipette or small squeeze bottle with a dropper tip.

In another embodiment, said unit dose is a container to which a device for the placement of eye drops may be applied.

In another embodiment, said unit dose is a container capable of atomizing drops or droplets.

In another embodiment, said unit dose is a disposable syringe.

In one embodiment of the invention, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 8 to about 40 μg to prevent, stabilize and/or inhibit lymph and blood vascularization or corneal angiogenesis.

In one embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 10 to about 35 μg.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 12 to about 30 μg.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 14 to about 25 μg.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 16 to about 20 μg.

In one embodiment of the invention, said pharmaceutical composition is to be administrated as drops of 50 μl per eye. It is generally acknowledged that, when a pharmaceutical composition is administrated in the form of an eye drop i.e. 50 μl, only about 10 μl may stay on the eye.

In another embodiment of the invention, said pharmaceutical composition is to be administrated once, twice, three or more times a day.

In one embodiment, said pharmaceutical composition is to be administrated once a day.

In another embodiment, said pharmaceutical composition is to be administrated twice a day, preferably in the morning and in the evening.

According to the invention, the inventors demonstrated that the amount of said antisense oligonucleotide to be administrated per eye per day is from about 20 to 100 μg per drop to stabilize or inhibit the neovascularization.

In one embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 30 to about 90 μg per drop.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 40 to about 90 μg per drop.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 50 to about 90 μg per drop.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 60 to about 90 μg per drop.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 70 to about 90 μg per drop.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 80 to about 90 μg per drop.

In one embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 40 to about 50 μg, preferably about 43 μg: for example, 20 to 25 μg per drop with an administration of 2 drops per eye per day.

In another embodiment, the amount of said antisense oligonucleotide to be administrated per eye per day is from about 80 to about 100 μg, preferably about 86 μg: for example, 40 to 50 μg per drop with an administration of 2 drops per eye per day.

In said embodiment, the pharmaceutical composition is preferably in the form of a unit dose for administering from about 80 to 100 μg, preferably about 86 μg, of said antisense oligonucleotide per eye per day.

For example, two drops of 50 μl of a composition comprising 0.80 to 1 mg/ml of said antisense oligonucleotide are administrated per eye in one time to the subject in need thereof. In another example, one drop of 50 μl of a composition comprising 1.60 to 2 mg/ml of said antisense oligonucleotide is administrated per eye to the subject in need thereof.

In another example, one drop of 50 μl of a composition comprising 0.80 to 1 mg/ml of said antisense oligonucleotide is administrated per eye twice a day to the subject in need thereof.

The pharmaceutical composition of the invention as described here above is for preventing, stabilizing and/or inhibiting the blood and lymph vascularization.

In one embodiment, said pharmaceutical composition as described here above is for treating corneal graft rejection. In one embodiment, the pharmaceutical composition of the invention is indicated for reducing the risk of immune rejections after corneal grafting.

In another embodiment, said pharmaceutical composition as described here above is for treating glaucoma. In one embodiment, glaucoma is selected in the group of primary open angle glaucoma (POAG), primary angle closure glaucoma, normal tension glaucoma (NTG), pediatric glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma, traumatic glaucoma, neovascular glaucoma, irido corneal endothelial glaucoma. Primary open angle glaucoma is also known as chronic open angle glaucoma, chronic simple glaucoma, glaucoma simplex.

Normal tension glaucoma is also known as low tension glaucoma. Primary angle closure glaucoma is also known as primary closed-angle glaucoma, narrow-angle glaucoma, pupil-block glaucoma, acute congestive glaucoma. Pediatric glaucoma include congenital glaucoma, infantile glaucoma and juvenile glaucoma. Secondary glaucoma include pseudoexfoliative glaucoma, also known as exfoliation glaucoma or glaucoma capsulare, pigmentary glaucoma, traumatic glaucoma, neovascular glaucoma, irido corneal endothelial glaucoma.

In one embodiment, the composition of the invention is for preventing, treating and/or inhibiting diseases, disorders or conditions of the posterior segment of the eye. As used herein, the term “posterior segment of the eye” refers to the back two third of the eye. The posterior segment of the eye comprises the posterior chamber, the vitreous cavity, the choroid, the macula, the retina and blood vessels and nerves which vascularize or innervated a posterior ocular region or site. Examples of diseases, disorders or conditions of the posterior segment of the eye include, but are not limited to, uveitis, choroiditis, retinochoroiditis, chorioretinitis, retinal degeneration, AMD (such as, for example, wet and dry AMD), retinal detachment, retinal neovascularization, proliferative vitreoretinopathy, retinopathy of prematurity (ROP), diabetic retinopathy, posterior segment trauma, retinal vascular pathologies, endophthalmitis, macular edema and inflammatory pathologies of the retina.

In one embodiment, said pharmaceutical composition as described here above is for treating retinopathy, especially diabetic retinopathy and retinopathy of prematurity.

In another embodiment, said pharmaceutical composition as described here above is for treating age related macular degeneration (AMD), such as, for example, wet AMD and dry AMD.

In one embodiment, the composition as described here above is for reducing the number of lesions of choroidal neovascularization (CNV), preferably the number of lesions of grade III and/or IV. CNV is a common symptom of wet AMD. In one embodiment, the composition of the invention is for treating choroidal neovascularization, preferably by reducing the number of lesions of grade III and/or IV.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawings will be provided by the Office upon request and payment of the necessary fee.

FIG. 1. Image analysis of corneal neovascularization from digitized slit-lamp pictures a) Original image of patient picture; b) the original image was shading-adjusted to balance inhomogeneous illumination; c) the shading-corrected image was separated into the red, green and blue phases, and the green phase was subtracted from the red phase to enhance contrast; d) contrast and shading were optimized again in the subtracted image; e) to detect the vessels, the region of interest (ROI) was first set along the limbus (red circle); f) the gray value range was then adjusted, including the dark vessels, and excluding the brighter background; g) the area defined by threshold setting was measured and h) calculated (total area in pixel²) and normalized to the total ROI (area ratio in %).

FIG. 2. GS-101 eye drops twice daily inhibited corneal neovascularisation. a) Baseline picture before GS-101 therapy; 1)) Visit 3-picture after 3 months of treatment; arrows indicate vascularized area.

FIG. 3. Graded scoring of week 4 fluorescein angiography image series collected from eyes following administration of an emulsion of GS-101 or of vehicle. Images illustrate percent incidence of each grade classification.

FIG. 4. Difference in late phase (6 minute) mean relative fluorescein intensity week 4 post-laser treatment in GS-101 and vehicle treated eyes as determined by imageJ analysis. Vertical bars indicate SEM. Asterisk (*) indicates p=0.0186, versus vehicle-treated eyes.

FIG. 5. Mean maximal CNV complex area at week 4 post-laser treatment in GS-101 and vehicle-treated eyes as determined by imageJ analysis of OCT images. Vertical bars indicate SEM. Asterisks indicate p<0.0001 versus eyes receiving vehicle. Data presented represent back-transformed data following Box-Cox transformation of raw CNV complex area data for one-way ANOVA and post hoc evaluation.

EXAMPLES

The following non limiting examples illustrate certain aspects of the present invention

Example 1 Patients and Methods Participants

The ongoing phase II study is a 6-month, double-blind, randomized, placebo-controlled trial of GS-101 eye drops to define efficacy and optimal dose in the treatment of progressive corneal neovascularization in men and women suffering from keratitis or keratouveitis of infectious, inflammatory or traumatic origin. Progression of neovascularization was documented during a period of at least 2 weeks and up to 3 months prior to inclusion (as documented by at least 2 photos of the injured cornea) of all participants.

Neovascularization was linked to contact lens misuse in 7 patients (17.5%), pseudomonas keratitis in 2 patients (5%), herpes simplex keratitis in 7 patients (17.5%), herpes zoster keratitis in 1 patient (2.5%), Fuchs-Stevens-Johnson syndrome in 2 patients (5%), other immunologic diseases in 4 patients (10%), prior surgery in 2 patients (5%), alkali burns in 9 patients (22.5%), graft rejection in 5 patients (12.5%), degenerative disorders in 1 patient (2.5%).

An institutional review board for each of the participating institutions approved the study. Participants provided written informed consent before study participation. The study was performed according to the Declaration of Helsinki and ICH Good Clinical Practice standards. This trial was registered under the following number in the Eudract database: 2004-005015-29 with the Protocol Code Number GS101-P2-CG.

Study Design

Eligible participants were randomly assigned to receive GS-101 (43, 86 or 172 μg/day as 2 eye drops, one in the morning and one in the evening) or placebo (2 eye drops, one in the morning and one in the evening; vehicle was used as control). Random assignment was performed by pre-allocated blocks (of 8 patients) to study centres; there was no stratification. All patients and study personnel were blinded to treatment assignments. All patients continued the standard therapy when appropriate (i.e. the ongoing local or systemic therapy for the corneal disease patients were suffering from). In case of bilateral lesion, only one eye was treated with GS-101 eye drops.

The primary end point for this phase II study is the efficacy of the test compound (i.e. inhibition and regression of pathologic corneal neovascularization) and secondary end points are visual acuity and safety of the treatment. In a protocol-specified interim analysis of the first 40 participants, change in the rate of corneal neovascularization was assessed in order to obtain insight on the tolerability and safety of the compound in patients with a damaged cornea. Thirteen participants (33%) were excluded from the interim efficacy analysis because of non-compliance to the treatment (2), non-analysable pictures (4), data not available (4) or adverse events (3) (in contrast, all patients were included for the safety analysis). The strict application of the study protocol was responsible for the exclusion of the majority of these cases. The number of excluded patients was similar between all study groups. These patients are, however, included in the safety analysis. The efficacy variables for this interim analysis were the change in the corneal area invaded by neovessels from baseline to month 3.

Image Analysis and End Point Criteria

Pictures of the cornea were taken at baseline and at week 4 and month 3. The standardized conditions and technical modalities for these photographs are described in the protocol and below. The photos assessing neovascularization were analysed blindly by semi-quantitative measurement and computerized morphometry at the central laboratory (Corneal Angiogenesis Laboratory, Dept. of Ophthalmology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany). The extent of corneal neovascularization was determined by repeatedly performed standardized digital slit-lamp pictures, which were then analyzed morphometrically using image analysis software based on grey filter sampling (Cell: Olympus Soft Imaging Solutions GmbH, Münster, Germany; FIG. 1). Specifically, standardized corneal slit-lamp pictures were digitized and modified by filters as follows: 1) Shading adjustment to balance inhomogeneous illumination; 2) The colour picture was separated into the red, green and blue phase; 3) Green phase was subtracted from red phase to enhance contrast and 4) contrast and shading were optimized. To detect the vessels, first the region of interest (ROI) was set along the limbus, the gray value range was then adjusted, including the dark vessels and excluding the brighter background. The area defined by threshold setting was calculated and normalized to the total ROI (expressed as a percentage covered by blood vessels). A detailed description of the method for animal use was recently published.

Evolution of corneal neovascularization was analyzed as a continuous variable and also as a categorical variable where the dynamic of neovascularization was dichotomized as <<progression>> or <<regression>>. Regression was considered clinically significant if the area of corneal neovascularization measured at baseline was reduced by more than 10% at evaluation time. The exact criteria used to dichotomize progression are as follows:

-   Progression: (Vascularized area at evaluation time)>[(Vascularized     area at baseline)−(10% from vascularized area at baseline)] -   Regression: (Vascularized area at evaluation time)<[(Vascularized     area at baseline)−(10% from vascularized area at baseline)]

On screening and at each visit onward, a complete ophthalmic assessment was performed by the investigator. This included visual acuity (expressed on a 10° scale), corneal sensitivity, slit lamp biomicroscopy (cornea, iris, lens and vitreous), fluorescein staining test (search for corneal ulcerations and epithelial defects) and intraocular pressure (IOP).

Statistical Analysis

Statistical analyses were performed with SAS release 9.1 (SAS Institute Inc., Cary, N.C., USA) and were conducted blindly using coded groups A, B, C and D according to the protocol. The unit of analysis was the patient, since even in case of bilateral lesions, only one eye was treated.

Because the interim analysis allowed for an early look at efficacy data, the alpha level was adjusted: the interim analysis was conducted at a significance level of 0.015. This yielded a significance level of 0.0414 for the final analysis.

The progression of corneal neovascularization was analyzed using an analysis of covariance (ANCOVA) model with a term for group (A, B, C, D) and cell area at baseline as a covariate. This model was used to estimate progression within each group and to compare the mean progression between the four groups. In the presence of a statistical difference between groups at the significance level of 0.015, the statistical blind was uncovered and pair-wise comparisons versus placebo were conducted with a significance level of 0.005 (0.015/3).

Considering the small sample size, the four groups were also compared using a Fisher exact test. The four groups were compared as categorical variable using a Fisher's exact test, which is more accurate than the chi-squared test when the expected numbers are small. In the presence of a statistical difference between groups at the significance level of 0.015, the statistical blind was uncovered, and pair-wise comparisons vs. placebo were conducted using the Fisher exact test with a significance level of 0.005 (0.015/3).

Results

The interim analysis included 40 participants between January 2006 and June 2007, assigned to receive either placebo (n=10) or GS-101 (n=10 per group; 3 different concentrations). Thirteen participants (33%) were excluded from the interim analysis (see methods and patients section). The remaining 27 patients constitute the patient population of this interim analysis. Baseline characteristics were similar between the groups (Table 1).

TABLE 1 Baseline demographics and neovascularized corneal area. Group 43 μg/d Group 86 μg/d Group 172 μg/d (0.43 mg/ml) (0.86 mg/ml) (1.72 mg/ml) Placebo Baseline data (n = 6) (n = 7) (n = 8) (n = 6) Age Mean ± SD 44.7 ± 11.5 38.9 ± 18.4 51.8 ± 23.9 42.7 ± 8.4 Median 42.5 36.0 50.0 40.50 Q1, Q3 37.0, 48.8 22.5, 54.0 33.5, 72.5 36.5, 46.0 Min, Max 33, 64 19, 64 19, 81 35, 57 Gender Male (%) 4 (66.7%) 6 (85.7%) 6 (75%) 5 (83.3%) Female (%) 2 (33.3%) 1 (14.3%) 2 (25%) 1 (16.7%) Vascularized Mean ± SD 8.88 ± 4.09 8.92 ± 5.38 8.13 ± 3.06 9.87 ± 6.99 area at Median  8.03  6.57  7.47  9.41 baseline (% of Q1, Q3 5.55, 11.20 4.62, 11.93 6.15, 9.45 3.37, 13.94 total corneal Min, Max 4.87, 15.61 4.87, 18.96 4.47, 14.42 3.09, 19.75 area) Vascularized Mean ± SD 8.94 ± 6.23 6.87 ± 6.01 9.74 ± 8.42 10.71 ± 6.40 area at 3 Median  7.73  5.09  6.70  9.51 months (% of Q1, Q3 4.58, 9.47 2.60, 10.37 5.22, 15.57 4.98, 17.85 total corneal Min, Max 3.36, 20.81 1.63, 18.83 0.06, 22.83 4.54, 17.88 area) SD: standard deviation; Q1; Q3: first and third quartile.

Adverse events were reported for all 40 patients. A total of 57 adverse events were reported. The adverse events were of mild (68%), moderate (25%) and severe (7%) intensity. Three adverse events (5.5%) in 3 patients were considered as possibly related to the study products by the investigators and one of these adverse events (“painful eye and pressure sensation” in patient 01-001) led to study drug interruption. Sensation of ocular pain and pressure disappeared after interruption of the treatment. Eight adverse events in 6 patients were classified as serious according to standard definitions of serious adverse events. All of these serious adverse events were assessed as not related to the study drug.

The overall progression of corneal neovascularization (Table 2) was assessed using an analysis of covariance (ANCOVA) model with one term for the treatment group and for the cell area at visit 1 (baseline). This model provides estimates of progression within each group and compares progression between the four groups. The comparison of the four groups yields a p-value of 0.1256, which failed to reach the significance level of 0.015 required for this interim analysis.

TABLE 2 Main efficacy variable: cell area progression after 3 months of treatment and ANCOVA parameters. Group 43 μg/d Group 86 μg/d Group 172 μg/d Baseline vs. (0.43 mg/ml) (0.86 mg/ml) (1.72 mg/ml) Placebo 3-month variation (n = 6) (n = 7) (n = 8) (n = 6) Change in Mean ± SD +0.07 ± 2.94 −2.04 ± 1.57 +1.60 ± 7.63 +0.89 ± 2.15 vascularized Median −0.17 −1.55 −0.30 +0.64 area (% of Q1, Q3 −2.19, +0.96 −2.99, −0.70 −3.73, +6.76 −0.65, +2.65 total corneal Min, Max −3.22, +5.19 −4.77, −0.13 −6.08, +13.41 −1.90, +3.94 area) ANCOVA Estimated +0.0661 −2.042 +1.624 +0.855 P = 0.1256 progression S.E.  1.180  0.607  2.699  0.962 95% C.I. −3.022, 3.154 −3.560, −0.524 −4.754, 8.001 −1.806, 3.515 C.I.: confidence interval; S.E.: standard error; SD: standard deviation; Q1; Q3: first and third quartile.

Following the ANCOVA analysis, Fisher exact tests were performed on the evolution of neovascularization as categorical variable (“progression” or “regression”). Calculation showed that there was a significant statistical difference between all groups (p=0.015). Blinding was uncovered in order to conduct pair-wise comparisons of each active treatment group versus placebo using the Fisher exact test with a significance level of 0.005 (namely: 0.015/3) as stated in the protocol. Comparing the ratio of regression and progression of neovascularization among the groups revealed that at a dosage of 86 μg GS-101 daily corneal neovascularization regressed significantly (p=0.0047) (Table 3, FIG. 2).

TABLE 3 Fisher exact tests on the evolution of neovascularization under topical treatment with GS101 eye drops versus placebo. Group Group Group 43 μg/d 86 μg/d 172 μg/d (0.43 mg/ml) (0.86 mg/ml) (1.72 mg/ml) Placebo Neovascularization (n = 6) (n = 7) (n = 8) n = 6 Progression n (%) 4 (66.7) 1 (14.3) 5 (62.5) 6 (100) Regression n (%) 2 (33.3) 6 (85.7) 3 (37.5) 0 (0)  P value 0.4545 0.0047 0.2088

Furthermore, the two other doses of GS-101 tested appeared active, although the differences observed did not reached statistical significance, i.e. p=0.4545 for the group treated with 43 μg daily and p=0.2088 for the group treated with 172 μg daily. With the lower concentration of GS-101, progression of corneal neovascularization tended to stabilize as revealed by both the mean (0.07±2.94) and median (−0.17) changes in neovascularization area (Table 2). Surprisingly, in the high dose GS-101 (172 μg daily) group, an apparent progression (mean=1.60±7.63) of corneal neovascularization was seen. Further analysis showed 2 outliers as seen by the large inter quartile range and the wide min-max range (Table 2), which were caused by 2 non-responding patients. By excluding the data of these 2 patients a similar regression of corneal neovascularization to the GS-101 86 μg group was obtained.

Although not subjected to analysis at this time of the study, the mid-treatment data on visual acuity suggest an improvement in patients under active treatment.

Discussion

The demonstration that GS-101 eye drops stopped progression of corneal neovascularisation and even induced regression of newly outgrowing blood vessels in the interim analysis of this phase II trial is therefore of great therapeutic interest. Even more since the safety data suggest the eye drops to be well tolerated.

Example 2 Formulations of GS101 Compositions Emulsions:

Phases composition % masse A Caprilic acid and capric mix: Miglyol 812N 8.00 A Glyceryl Stearate and PEG-75 1: Gelot 64 3.50 A Cetylic alcohol 2.00 B Carbomer: Carbopol 980 NF 0.05 B Purified H2O Qsp 100% (61.99)  C 10% NaOH Solution Qsp pH 7 (0.29) D Glycerol 5.00 D Urea 4.00 E GS101  0.172* E Purified H2O 15.00  *with purity (97.36%) and water content (8.31%): 192.68 mg

Phases composition % masse A Caprilic acid and capric mix: Miglyol 812N 8.00 A Glyceryl Stearate and PEG-75 1: Gelot 64 3.50 A Cetylic alcohol 2.00 B Carbomer: Carbopol 980 NF 0.05 B Purified H2O Qsp 100% (66.06)  C 10% NaOH Solution Qsp pH 7 (0.22) D Glycerol 5.00 E GS101  0.172* E Purified H2O 15.00  *with purity (97.36%) and water content (8.31%): 192.68 mg

Ointment:

composition % masse GS101 0.172* Paraffin oil 60.03 Vaseline oil 39.80 *with purity (94.65%) and water content (8.4%): 198.38 mg

Collyre:

composition % masse GS101 0.086* NaCl 0.9% Qsp 100% *with purity (96.4%) and water content (5.21%): 94.1 mg

Example 3 Experimental Approaches

The purpose of this research project was to evaluate the efficacy of a topical application twice a day of an emulsion of GS-101 in a model of “wet” age-related macular degeneration (AMD) in the African green monkey. This model uses argon laser-mediated photocoagulation. The resulting choroidal neovascularization (CNV) growth and injury to the retina following laser treatment closely models the clinical complications of wet AMD.

Animals

The effect of a topical administration of an emulsion of GS-101 on laser-induced CNV was assessed in 20 male adult African green monkeys, ranging in weight from 3.70-6.58 kg. Subjects were estimated to be between 4-6 years old by weight and dentation. Subjects were anesthetized with ketamine/xylazine IM [8.0 mg/kg ketamine (Fort Dodge)/1.6 mg/kg xylazine (Lloyd Lab) in a sterilely mixed cocktail] for all procedures and ophthalmic evaluations. General wellbeing was assessed before, during and after sedation.

Animals were randomly assigned to one of 4 groups (6 animals per experimental group, 2 animals for the vehicle control group). On day 1, six laser spots were concentrically spaced approximately 1.5 disc diameters from the fovea at the anatomic periphery of the macula, within the temporal vascular arcades of both eyes for all 20 study animals. Laser spots were applied using an Iridex Oculight TX 532 nm laser with laser energy of 800 mW, pulse duration at 100 ms, and spot size at 50 μm. The laser was mounted on a slit lamp with a slit lamp adapter and the laser beam directed to the retina with a Volk Centralis Direct ANF+ 0.9× laser lens with a 10 mm contact diameter (Volk Optical, Mentor, Ohio), providing a 1.11× laser spot size magnification. Saline was used as the coupling agent between the lens and the cornea. Fundus photographs were taken immediately prior to and immediately following laser photocoagulation in each eye.

Eyes were examined by slit lamp and indirect ophthalmoscopy at baseline and week 3 and week 4. Fundus images and angiograms were collected on OS (left eye) followed by OD (right eye) on days 22, and 29 using a Topcon TRC-50X retinal camera with Canon 5D digital imaging hardware and New Vision Fundus Image Analysis System software. Fluorescein angiography in OS preceded angiography in OD by 5-24 hours to allow washout of the fluorescein between angiogram image series. For fundus color images, red free images and fluorescein angiograms, monkeys were anesthetized with ketamine/xylazine before systemic administration of 0.1 ml/kg of 10% sodium fluorescein. After obtaining color and red free fundus images, the first angiogram image was collected at the moment the intravenous fluorescein injection was completed, and then every 2.5 seconds starting at 20 seconds after start of the injection until 40 seconds, then every 5 seconds until 60 seconds, then every 20 seconds until 2 minutes, then every 60 seconds until 3 minutes, then again at 6 and 10 minutes. An angiogram image was also collected from the contralateral eye after collection of the 10-minute image. This imaging sequence assured reliable documentation of early and late fluorescein leakage at consistent post-fluorescein administration time points.

Eyes were additionally examined by optical coherence tomography (OCT) on study day 29 using a Heidelberg Instruments Spectralis OCT Plus system (Vista, Calif.) and Heidelberg Eye Explorer (Heyex) software (v1.6.1.).

Clinical observations were conducted at each angiogram time point to confirm integrity of the ocular surface and normal response to mydriatics. Fundus photographs were reviewed to confirm perimacular placement of laser lesions and the degree of post-treatment blanching, retinal/subretinal hemorrhage and scaring, and their resolution over time. Photographic findings were correlated with clinical observations and angiographic findings.

Test Compound Delivery

Topical dosing with an emulsion comprising GS-101 or GS-101 vehicle was initiated 2 days prior to laser photocoagulation with 54 μl of test agents administered twice daily (BID). Three doses of GS-101 (21.5 μg, 43 μg or 86 μg) were administered. The GS-101 vehicle was administered to a separate cohort of animals (n=2 animals) to serve as a negative control group. Topical dosing continued for 14 days after laser photocoagulation (16 days in total).

Screening and Interval Exams

Ophthalmic exams were conducted by direct external inspection, slit lamp biomicroscopy and indirect retinoscopy of each eye. Exams were performed as part of baseline screening, pre- and post-laser photocoagulation and at day 22. A general assessment of physical condition was also conducted prior to enrollment and throughout the study by clinical observation.

Graded Scoring

Graded scoring of angiograms was performed on fluorescein angiogram series collected on week 4, performed on successive imaging sessions to allow clearance of fluorescein from ocular tissues between angiogram series in the right and left eye (thus minimizing camera movements and maximizing image quality). Prior to graded scoring, all angiogram images were enhanced for image intensity to facilitate review by masked investigators. All 30 second and 6 and 10 minute angiograms were enhanced in identical fashion using preset actions in Adobe Photoshop to uniformly brighten images and minimize the impact of the inherent variability of image intensity on visual scoring. The 30 second images were also prepared using a −2 stop exposure to facilitate evaluation of early phase hyperfluorescence. Each angiogram series was reviewed to confirm overall consistency in the quality and sequence of images collected, and early phase (30 seconds) and later phase images (6 and 10 minutes) were compiled for comparative assessment. For week 4 angiograms the extent of late phase fluorescein leakage at each lesion site, an angiographic change associated with CNV, was rated on a I to IV scale with I=no hyperfluorescence; II=hyperfluorescence without leakage and no significant residual staining in late phase angiograms; III=hyperfluorescence early or mid-transit with late leakage and significant residual staining; IV=hyperfluorescence early or mid-transit with late leakage extending beyond the borders of the treated area. Lesions were graded systematically from the 12 o'clock position in a clockwise manner and the lesion position confirmed diagrammatically so that inter-rater performance could be compared. Following inter-rater reliability assessments, any individual lesions that demonstrated differing grades (between separate assessors) were simultaneously reevaluated such that a final grading could be assigned and agreed upon by all assessors. Scoring was conducted by two investigators who remained masked to treatment group.

ImageJ Scoring

Original, non-enhanced angiogram jpg files were further assessed using ImageJ (Rasband, W.S., ImageJ, U.S. National Institutes of Health, Bethesda, Md., USA, http://rsb.info.nih.gov/ij/, 1997-2009). Relative late-phase fluorescein intensity was quantified by assessment of background-corrected spot intensity in 6-minute angiograms. Lesions were graded systematically from the 12 o'clock position in a clockwise manner and the lesion position confirmed diagrammatically so that inter-rater performance could be compared. A 300×300 pixel circle was drawn and positioned over an area of the angiogram representing background signal in the absence of choriocapillaris signal, the fluorescein intensity (measured as mean gray value in ImageJ) from this background measure was then subtracted from all subsequent measures from that specific angiogram. This process was repeated for each individual angiogram. A 300×300 pixel circle was subsequently positioned centrally over each lesion spot (300×300 corresponded to the maximum lesion size observed in these studies) and fluorescein intensity measured. Background-corrected measures were taken from each spot at 6 minutes. This process was repeated for each eye.

Optical Coherence Tomography (OCT)

OCT was performed on all eyes at week 4 using a Heidelberg Spectralis OCT Plus with eye tracking and HEYEX image capture and analysis software. Star-shaped OCT scans centered on each laser spot were performed, as well as an overall volume scan of the entire macula encompassing the six laser spots at a dense scan interval. Star-shaped scans consisted of 12 scans intersecting at 15° in a clock pattern with image averaging over 25 ART frames. The dense retinal volume scans, which were obtained for correlation with potential histological analyses, consisted of 48 parallel scans of 30° in the horizontal plane positioned 50 μm apart with image averaging over 50 ART frames with scan grid centered on the fovea.

Quantitative CNV scoring was applied to acquired OCT images by definition of the principal axis of maximal CNV complex formation within each star-shaped scan at each laser lesion by a masked evaluator. The CNV complex area in the OCT image in that axis was then measured using the freehand tool within ImageJ to delineate the CNV complex boundary and calculate maximum complex area in square microns (μm²).

Histopathology

Eyes were enucleated at day 33 and fixed in Davidson's fixative for 24 hours followed by transfer to 70% ethanol for potential future histological analyses, pending full review of in-life data.

Statistical Methods

Graded (I-IV) scoring of lesions was analyzed using the Fisher's exact probability test where incidence of either grade IV, grade III or both grade III and IV lesions was assigned ‘Yes’ and any other grading assigned ‘No’. ImageJ-based analysis of background-corrected mean fluorescein intensity and OCT derived CNV complex area was analyzed using a one-way ANOVA on Box-Cox-transformed values with post-hoc analysis using Tukey-Kramer HSD. All statistics were performed using the statistical analysis software JMP (SAS Institute, Cary, N.C.). P values<0.05 were considered statistically significant.

Results Graded Angiography Scoring

The anti-angiogenic capacity of GS-101 was evaluated at doses of 21.5, 43 and 86 jag, administered BID for 16 days, and compared with eyes receiving GS-101 vehicle in an identical treatment paradigm. Laser-induced CNV was assessed by graded scoring of week 4 fluorescein angiograms (I-IV; as defined hereinabove). Scoring was conducted on Photoshop enhanced images by an examiner masked to treatment. Results are shown on FIG. 3 and on Table 4.

TABLE 4 Lesion Scoring Summary (Week 4) Total Number of lesions number of (% of total number of lesions) lesions Treatment Grade I Grade II Grade III Grade IV (%) GS-101 0 (0) 44 (56.4) 18 (23.1) 16 (20.5) 78 (100) Vehicle 21.5 μg 0 (0) 56 (77.8)  8 (11.1)  8 (11.1) 72 (100) GS-101 43 μg GS-101 0 (0) 31 (86.1) 2 (5.6) 3 (8.3) 36 (100) 86 μg GS-101 3 (5) 55 (91.7) 1 (1.7) 1 (1.7) 60 (100)

Grade III and IV lesions have previously been reported to represent clinically significant CNV (Lichtlen P D et al, Invest Ophthalmol V is Sci, 2010, 51(9):4738-45 and Goody et al, Experimental eye research, 2011, 92(6):464-72).

Administration of GS-101 demonstrated a robust dose-dependent effect on the incidence of grade III and IV lesions (FIG. 3). At the highest dose assessed (86 μg), GS-101 treatment resulted in a significant reduction in the incidence of grade IV lesions compared with vehicle-treated eyes (p=0.000456). Incidence of grade III lesions was also significantly lower in eyes receiving 86 μg GS-101 than those that received vehicle (p=0.000132). At the 43 μg dose of GS-101 a decrease in the incidence of grade IV lesions was observed but this effect was not significantly different from vehicle-treated animals (p=0.0843). However, incidence of grade III lesions (p=0.0166) and that of combined grade III and IV lesions (p=0.00133) was significantly lower compared with vehicle-treated eyes. Similarly, the low dose of GS-101 (21.5 μg) also demonstrated a modest but non-significant decrease in incidence of grade IV lesions (p=0.0884) yet resulted in significantly reduced incidence of grade III lesions (p=0.0418) and combined grade III and IV lesions (p=0.00982) compared with the vehicle-treated cohort.

ImageJ Scoring

CNV development was also assessed by ImageJ analysis of non-enhanced digital versions of 6 minute fluorescein angiograms to provide comparison of late phase relative fluorescein intensity in lesions from the GS-101 and vehicle-treated eyes at week 4. Fluorescein signal intensity in laser spots was compared between groups by one-way ANOVA analysis (FIG. 4). The high (86 μg) dose of GS-101 induces a significant reduction in late phase fluorescein intensity observed (p=0.0186) compared with vehicle-treated eyes.

Optical Coherence Tomography

Choroidal neovascular complex formation was quantified in each laser photocoagulation site by area analysis of cross sectional OCT images. The OCT image axis demonstrating maximal CNV complex area was selected and CNV area for the target spot delineated using the freehand tool in ImageJ. Complex areas were calculated in square microns in ImageJ, employing scale bar capabilities incorporated into image collection using the Spectralis OCT plus and accompanying software. Mean maximal CNV complex areas were significantly lower in eyes receiving 86 μg GS-101 than observed in eyes receiving the GS-101 vehicle (p<0.0001 for each, see FIG. 5).

Discussion

Together these findings demonstrate a consistent inhibitory effect of the topical administration of an emulsion of GS-101 on laser-induced CNV. identifying GS-101 as a very promising candidate for wet AMD. 

1. A pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase.
 2. The pharmaceutical composition according to claim 1, wherein the aqueous phase further comprises a viscosity modifying agent.
 3. The pharmaceutical composition according to claim 1, wherein the aqueous phase further comprises a viscosity modifying agent selected from the group consisting of a hydrogel of sodium hyaluronate, polymers of acrylic acid, hydroxyethyl cellulose, dextran, carboxymethyl cellulose, polyethylene glycol, polyvinyl alcohol and collagen.
 4. The pharmaceutical composition according to claim 1, wherein the oily phase comprises oils selected from the group consisting of vegetable oil; triglycerides; monoglycerides; diglycerides; oily fatty acids; isopropyl myristate; oily fatty alcohols; esters of sorbitol and fatty acids; oily sucrose esters, mineral oils, and mixtures thereof.
 5. The pharmaceutical composition according to claim 1, wherein the oily phase comprises a surfactant.
 6. The pharmaceutical composition according to claim 1, wherein the oily phase comprises a surfactant selected from the group consisting of naturally-occurring gums; naturally-occurring phosphatides; esters or partial esters derived from fatty acids and hexitol anhydrides; condensation products of the said partial esters with ethylene oxide; sorbitan ester; bentonite; glycerin monostearate; glyceryl monooleate and propylene glycol monolaurate or mixtures thereof; glyceryl stearate; poloxamer 188; poloxamer 282; poloxamer 407; tyloxapol; vitamin E D-polyethylene glycol succinate; polyethylene glycol (PEG); cetostearyl alcohol; cholesterol; ethylene glycol palmitostearate; lauric acid; myristic acid; myristyl alcohol; linoleic acid; oleic acid; palmitic acid; polysorbate 20 (Tween 20); sorbitan trioleate (Span 85); phospholipids; and mixture thereof.
 7. The pharmaceutical composition according to claim 1, wherein the oily phase comprises a thickening agent.
 8. The pharmaceutical composition according to claim 1, wherein the oily phase comprises a thickening agent selected from the group consisting of beeswax, hard paraffin and cetylic alcohol.
 9. The pharmaceutical composition according to claim 1, further comprising an osmolality modifying agent.
 10. The pharmaceutical composition according to claim 1, further comprising an osmolality modifying agent selected from the group consisting of NaCl, KCl, CaCl2, glycerol, mannitol, alpha-trehalose and propylene-glycol.
 11. The pharmaceutical composition according to claim 1, further comprising urea.
 12. The pharmaceutical composition according to claim 1, comprising: an aqueous phase, wherein the amount of the aqueous phase in the emulsion ranges from about 70 to 99% in weight to the total weight of the emulsion; and an oily phase, wherein the amount of the oily phase in the emulsion ranges from about 1 to about 30% in weight to the total weight of the emulsion; wherein the aqueous phase comprises: an antisense oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1; in an amount ranging from about 0.01 to about 0.3% in weight to the total weight of the emulsion; polymers of acrylic acid in an amount ranging from about 0.01 to about 0.1% in weight to the total weight of the emulsion; NaOH in an amount ranging from about 0.1 to about 0.5% in weight to the total weight of the emulsion; and optionally urea, in an amount ranging from about 0.5 to about 20% in weight to the total weight of the emulsion; and wherein the oily phase comprises: Medium Chain Triglycerides (MCT), in an amount ranging from about 1 to about 20% in weight to the total weight of the emulsion; a mixture of glyceryl stearate and of PEG-75 in an amount ranging from about 1 to about 10% in weight to the total weight of the emulsion; cetylic alcohol in an amount ranging from about 0.1 to about 10% in weight to the total weight of the emulsion; and optionally glycerol in an amount ranging from about 0.5 to about 25% in weight to the total weight of the emulsion.
 13. A unit dose container comprising the pharmaceutical composition according to claim
 1. 14. A unit dose container according to claim 12, capable of dispensing eye drops.
 15. A method for preventing, stabilizing and/or inhibiting blood and/or lymph vascularization, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase.
 16. A method for treating a disease of the posterior segment of the eye, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase.
 17. The method according to claim 16 for treating retinopathy comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase.
 18. The method according to claim 16 for treating age related macular degeneration, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase.
 19. The method according to claim 16 for treating choroidal neovascularization by reducing the number of grade III or grade IV lesions, comprising the topical administration to a subject in need thereof of a pharmaceutical composition, wherein said pharmaceutical composition is an oil-in-water emulsion comprising: an aqueous phase comprising as active agent, an antisens oligonucleotide having the sequence SEQ ID NO: 1 or any function-conservative sequence comprising from 9 to 30 nucleotides that has 75% of identity compared to SEQ ID NO: 1, wherein said antisens oligonucleotide is in a concentration from about 0.40 mg/ml to about 2 mg/ml; and an oily phase dispersed in the aqueous phase. 